<p>Brachial plexus palsy is an injury to part of the group of five large nerves leading from the spinal cord to the arm. This affects how your arm moves and feels things. Learn about causes and treatment for brachial plexus palsy.</p>

<p>Your child has been diagnosed with brachial plexus palsy. This information is intended to help you learn more about this condition and how it is managed. Each child with brachial plexus palsy is different and recovers differently. It is difficult to predict exactly what will happen with your child. Ask your child's physician and therapist for more specific information about your child's care.</p><h2>What is the brachial plexus?</h2><p>Brachial plexus is the name given to a group of five large nerves that exit from the spinal cord between the bones in the neck (the vertebrae). These nerves are represented by the symbols C5, C6, C7, C8 and T1. After leaving the neck, the nerves combine in a complex pattern. The brachial plexus then divides into individual nerves that travel to different muscles in the arm. The nerves of the brachial plexus allow the arm to move and feel things.</p>
<figure>
<span class="asset-image-title">Brachial plexus</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/brachial_plexus_infant_MED_ILL_EN.jpg" alt="Brachial plexus in the upper body of a baby" />
<figcaption class="asset-image-caption">The brachial plexus is an arrangement of nerves coming from the spinal cord in the neck, running under the collar bone, through the armpit, to the arm. It supplies nerve function to the muscles of the arm and hand.</figcaption> </figure>

<h2>Key points</h2>
<ul>
<li>The brachial plexus is a group of five nerves that leave the spinal cord between the bones in the neck. The nerves allow the arm to move and feel things.</li>
<li>In babies, the brachial plexus can be damaged during a difficult childbirth.</li>
<li>Nerves have some ability to heal and repair on their own, depending on how severely damaged they are.</li>
<li>If movement in the arm or hand is weak and function is limited, surgery may be recommended.</li>
<li>Many children regain good use of their affected arm and are able to do most of the activities that they want. There may still be some muscle weakness.</li>
</ul>

<h2>The brachial plexus may be damaged during birth</h2>
<p>Brachial plexus palsy usually occurs during a difficult childbirth. If the baby is large, the shoulders can become trapped after delivery of the head. To free the shoulders, the head must be tilted to the opposite side. Tension on the brachial plexus may stretch or pull apart the fibres within one or more nerves. Additional force on the plexus may rupture (tear) nerves entirely or tear them from the spinal cord. </p>
<p>If the brachial plexus becomes damaged, weakness shows up immediately in the arm.</p>
<h2>When nerve fibres are damaged, the muscles may be weakened</h2>
<p>When nerve fibres are damaged, the muscles connected to that nerve may be weakened. The term palsy means weakening of the muscles.</p>
<p>The damage is not to the muscle itself. Damaged nerve fibres located outside the spinal cord (peripheral nerves) may be able to regrow and reconnect to the muscles. </p>
<p>A scar may form at the site of the brachial plexus damage. This scar tissue may prevent electrical messages from getting to the muscles in order for them to work well. Replacing the scar with new nerves can help to improve function.</p>
<p>A nerve that is completely ruptured can only repair itself in a limited way, which means that only limited muscle recovery is possible. Ruptured nerves can be surgically repaired, which gives the muscles a better chance to work. </p>
<p>Nerves that have been torn from the spinal cord will not repair themselves. In this case, other nerves may be surgically connected to them. </p>
<p>Nerve fibres regrow at a rate of about 1 mm a day or 1 inch a month. It may take many months for regrowing fibres to strengthen the muscles in the arm. </p>

<h2>Severity of the brachial plexus palsy</h2>
<p>The severity of the palsy depends on the number of nerves that are affected and the amount of damage to each nerve.</p>
<p>The more nerves that are affected by the brachial plexus damage, the weaker the arm and hand will be:</p>
<ul>
<li>The first three nerves of the brachial plexus (C5, C6, C7) are most often involved in brachial plexus palsy in children. Weakness or paralysis of the muscles served by the first two or three nerves is called Erb's palsy. With Erb's palsy, there is often weakness of the shoulder and elbow.</li>
<li>If all five nerves of the brachial plexus are affected, the entire arm and hand will be weak or paralyzed.</li>
</ul>
<p>If the nerves have been only mildly stretched, your child may recover use of the arm quickly. If the nerves have been more severely stretched or pulled apart, the muscle will be weaker.</p>
<h2>Learning about your child's brachial plexus palsy</h2>
<p>Your child's doctor may need to perform different observations over time to find out how severe the damage is. On each visit, the health-care team will watch your child moving and playing and observe the movements of your child's arm. These movements will be scored. This will help the doctor to keep track of how well the nerves are healing. </p>
<p>If your child could benefit from surgery, the doctor may order other tests.</p>

<h2>Treatment for children with brachial plexus palsy</h2>
<h3>Time</h3>
<p>Most importantly, brachial plexus palsy needs time to heal. Most nerve and muscle recovery will happen in the first year. You will notice a gradual improvement in both the movement and strength in your child's arm. Further recovery may happen in the second year, but the effects will be more difficult to see.</p>
<h3>Physiotherapy</h3>
<p>Physiotherapy should be started early in a baby who has brachial plexus palsy. Physiotherapy can help prevent problems such as joint stiffness and delays in development. It will not help the nerves to heal faster.</p>
<p>The therapist will teach you how to hold and move your baby and about the best sleeping positions for your baby. You will also learn exercises to keep your baby's joints flexible and strengthen muscles that are beginning to work.</p>
<h3>Occupational therapy</h3>
<p>Occupational therapists evaluate and treat children with brachial plexus palsy in order to help them feed, dress and take care of themselves, and participate in school and leisure activities to the best of their abilities. The occupational therapist is able to guide the surgeon by defining problems in the use of the arm when surgery is being considered in older children.</p>
<h3>Surgery on the nerves</h3>
<p>In some patients, surgery may be recommended. Children with brachial plexus palsy are carefully monitored during the first year of life to record changes in muscle strength. If the muscle fails to strengthen beyond a certain point, and the child's ability to move and use the arm is also limited, then the surgeon may suggest an operation to find out how severely the nerve is damaged. When the surgeon can observe the brachial plexus directly, they can decide on the best form of treatment. If your baby has an operation on the nerves of the brachial plexus, this will usually be done before your baby is a year old. </p>
<p>For more information, please read: <a href="/Article?contentid=1033&language=English">Brachial Plexus Operation</a>.</p>
<h3>Other types of surgery</h3>
<p>Older children who still have movement problems or trouble using the arm may benefit from surgical procedures on the muscles, tendons or bones. Examples include tendon transfers and correction of bone alignment. Your child's surgeon will discuss these procedures with you if they are recommended. </p>

<h2>At SickKids</h2>
<p>The Brachial Plexus Clinic at The Hospital For Sick Children is a multidisciplinary clinic designed to assess and treat children with brachial plexus problems. Children are seen in the clinic every three months until one year of age, then as necessary thereafter. Your child's progress is monitored and carefully documented in order to determine the best forms of treatment. Surgery is recommended if necessary. Children continue to be monitored in the clinic throughout their childhood to measure the effect of growth and development on their ability to function.</p>
<p>Physiotherapy visits for patients with brachial plexus palsy are scheduled as needed, often beginning with monthly visits.</p>
<p>Occupational therapy assessment and treatment is arranged on an outpatient basis for children that require these services.</p>

<p>Brachial plexus palsy is an injury to part of the group of five large nerves leading from the spinal cord to the arm. This affects how your arm moves and feels things. Learn about causes and treatment for brachial plexus palsy.</p>

<p>Your child has been diagnosed with brachial plexus palsy. This information is intended to help you learn more about this condition and how it is managed. Each child with brachial plexus palsy is different and recovers differently. It is difficult to predict exactly what will happen with your child. Ask your child's physician and therapist for more specific information about your child's care.</p><h2>What is the brachial plexus?</h2><p>Brachial plexus is the name given to a group of five large nerves that exit from the spinal cord between the bones in the neck (the vertebrae). These nerves are represented by the symbols C5, C6, C7, C8 and T1. After leaving the neck, the nerves combine in a complex pattern. The brachial plexus then divides into individual nerves that travel to different muscles in the arm. The nerves of the brachial plexus allow the arm to move and feel things.</p>
<figure>
<span class="asset-image-title">Brachial plexus</span>
<img src="https://assets.aboutkidshealth.ca/akhassets/brachial_plexus_infant_MED_ILL_EN.jpg" alt="Brachial plexus in the upper body of a baby" />
<figcaption class="asset-image-caption">The brachial plexus is an arrangement of nerves coming from the spinal cord in the neck, running under the collar bone, through the armpit, to the arm. It supplies nerve function to the muscles of the arm and hand.</figcaption> </figure>

<h2>What are nerves?</h2>
<p>Nerves are cord-like structures of tissue formed from a collection of nerve fibres. Similar to a telephone cable, a single nerve may contain thousands of fibres. The fibres that make up the nerves of the brachial plexus carry electrical messages from the brain to the muscles and tissues of the arm. For a muscle to work (contract), a message must travel from the brain along a nerve that goes directly to the muscle.</p>

<h2>Key points</h2>
<ul>
<li>The brachial plexus is a group of five nerves that leave the spinal cord between the bones in the neck. The nerves allow the arm to move and feel things.</li>
<li>In babies, the brachial plexus can be damaged during a difficult childbirth.</li>
<li>Nerves have some ability to heal and repair on their own, depending on how severely damaged they are.</li>
<li>If movement in the arm or hand is weak and function is limited, surgery may be recommended.</li>
<li>Many children regain good use of their affected arm and are able to do most of the activities that they want. There may still be some muscle weakness.</li>
</ul>

<h2>The brachial plexus may be damaged during birth</h2>
<p>Brachial plexus palsy usually occurs during a difficult childbirth. If the baby is large, the shoulders can become trapped after delivery of the head. To free the shoulders, the head must be tilted to the opposite side. Tension on the brachial plexus may stretch or pull apart the fibres within one or more nerves. Additional force on the plexus may rupture (tear) nerves entirely or tear them from the spinal cord. </p>
<p>If the brachial plexus becomes damaged, weakness shows up immediately in the arm.</p>
<h2>When nerve fibres are damaged, the muscles may be weakened</h2>
<p>When nerve fibres are damaged, the muscles connected to that nerve may be weakened. The term palsy means weakening of the muscles.</p>
<p>The damage is not to the muscle itself. Damaged nerve fibres located outside the spinal cord (peripheral nerves) may be able to regrow and reconnect to the muscles. </p>
<p>A scar may form at the site of the brachial plexus damage. This scar tissue may prevent electrical messages from getting to the muscles in order for them to work well. Replacing the scar with new nerves can help to improve function.</p>
<p>A nerve that is completely ruptured can only repair itself in a limited way, which means that only limited muscle recovery is possible. Ruptured nerves can be surgically repaired, which gives the muscles a better chance to work. </p>
<p>Nerves that have been torn from the spinal cord will not repair themselves. In this case, other nerves may be surgically connected to them. </p>
<p>Nerve fibres regrow at a rate of about 1 mm a day or 1 inch a month. It may take many months for regrowing fibres to strengthen the muscles in the arm. </p>

<h2>Severity of the brachial plexus palsy</h2>
<p>The severity of the palsy depends on the number of nerves that are affected and the amount of damage to each nerve.</p>
<p>The more nerves that are affected by the brachial plexus damage, the weaker the arm and hand will be:</p>
<ul>
<li>The first three nerves of the brachial plexus (C5, C6, C7) are most often involved in brachial plexus palsy in children. Weakness or paralysis of the muscles served by the first two or three nerves is called Erb's palsy. With Erb's palsy, there is often weakness of the shoulder and elbow.</li>
<li>If all five nerves of the brachial plexus are affected, the entire arm and hand will be weak or paralyzed.</li>
</ul>
<p>If the nerves have been only mildly stretched, your child may recover use of the arm quickly. If the nerves have been more severely stretched or pulled apart, the muscle will be weaker.</p>
<h2>Learning about your child's brachial plexus palsy</h2>
<p>Your child's doctor may need to perform different observations over time to find out how severe the damage is. On each visit, the health-care team will watch your child moving and playing and observe the movements of your child's arm. These movements will be scored. This will help the doctor to keep track of how well the nerves are healing. </p>
<p>If your child could benefit from surgery, the doctor may order other tests.</p>

<h2>Treatment for children with brachial plexus palsy</h2>
<h3>Time</h3>
<p>Most importantly, brachial plexus palsy needs time to heal. Most nerve and muscle recovery will happen in the first year. You will notice a gradual improvement in both the movement and strength in your child's arm. Further recovery may happen in the second year, but the effects will be more difficult to see.</p>
<h3>Physiotherapy</h3>
<p>Physiotherapy should be started early in a baby who has brachial plexus palsy. Physiotherapy can help prevent problems such as joint stiffness and delays in development. It will not help the nerves to heal faster.</p>
<p>The therapist will teach you how to hold and move your baby and about the best sleeping positions for your baby. You will also learn exercises to keep your baby's joints flexible and strengthen muscles that are beginning to work.</p>
<h3>Occupational therapy</h3>
<p>Occupational therapists evaluate and treat children with brachial plexus palsy in order to help them feed, dress and take care of themselves, and participate in school and leisure activities to the best of their abilities. The occupational therapist is able to guide the surgeon by defining problems in the use of the arm when surgery is being considered in older children.</p>
<h3>Surgery on the nerves</h3>
<p>In some patients, surgery may be recommended. Children with brachial plexus palsy are carefully monitored during the first year of life to record changes in muscle strength. If the muscle fails to strengthen beyond a certain point, and the child's ability to move and use the arm is also limited, then the surgeon may suggest an operation to find out how severely the nerve is damaged. When the surgeon can observe the brachial plexus directly, they can decide on the best form of treatment. If your baby has an operation on the nerves of the brachial plexus, this will usually be done before your baby is a year old. </p>
<p>For more information, please read: <a href="/Article?contentid=1033&language=English">Brachial Plexus Operation</a>.</p>
<h3>Other types of surgery</h3>
<p>Older children who still have movement problems or trouble using the arm may benefit from surgical procedures on the muscles, tendons or bones. Examples include tendon transfers and correction of bone alignment. Your child's surgeon will discuss these procedures with you if they are recommended. </p>

<h2>Most children regain good use of their affected arm</h2>
<p>During the early months of life, it is hard to predict how your child's arm will heal. If muscle function returns quickly, it is a good sign. Many children regain good use of their affected arm and are able to do most of the activities that they want. However, some muscle weakness usually remains.</p>

<h2>At SickKids</h2>
<p>The Brachial Plexus Clinic at The Hospital For Sick Children is a multidisciplinary clinic designed to assess and treat children with brachial plexus problems. Children are seen in the clinic every three months until one year of age, then as necessary thereafter. Your child's progress is monitored and carefully documented in order to determine the best forms of treatment. Surgery is recommended if necessary. Children continue to be monitored in the clinic throughout their childhood to measure the effect of growth and development on their ability to function.</p>
<p>Physiotherapy visits for patients with brachial plexus palsy are scheduled as needed, often beginning with monthly visits.</p>
<p>Occupational therapy assessment and treatment is arranged on an outpatient basis for children that require these services.</p>

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